The move marks the first major personnel change in Royer’s brief tenure. He signed a six-month contract in late November to replace longtime CEO Ron Anderson while the hospital’s board searches for a permanent replacement. Royer is the founding CEO of CHRISTUS Health hospital corporation.

“One of our primary goals is to strengthen nursing operations throughout the Parkland system,” Royer said today in a press release. “Mary brings with her an energized and focused approach to designing and establishing a centralized, systems-oriented nursing model.”

Parkland is being forced to revamp its approaches to patient safety under a rare federal oversight program. The first comprehensive report on its progress is due to the U.S. Centers for Medicare & Medicaid Services later this month.

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For the first time in many years, the public now has another glimpse into a largely hidden national problem: deaths resulting from physical restraint inside hospitals and other care facilities.

It comes from a recent study by Equip for Equality, an Illinois nonprofit group that monitors treatment of people with physical, developmental and psychological disabilties. The organization investigated 61 fatalities across the country that occurred during or following the use of physical or mechanical restraints between 1999 and 2005.

What the study found may sound familiar to readers of this blog:

Nearly all who died had medical ailments – most frequently related to cardiac, neurological or respiratory conditions – that existed at the time they were restrained.

In the majority of deaths, unsafe and inappropriate methods were used: “Of 69 dangerous practices identified, 54 percent involved a person lying face down in a prone position.”

A “disturbing trend of nurses leaving the area where the individual was being restrained.”

In a quarter of the deaths, the anti-anxiety drug lorazepam – also known as Ativan – was administered while the patient was restrained: “Further examination and review of this issue is warranted.”

Strikingly, those circumstances also fit the case of schizophrenia patient George Cornell, who died in Parkland Memorial Hospital’s psychiatric emergency department last February.

Using government documents and medical records, we’ve reported how unlicensed psychiatric techs twice pinned Cornell, who had several cardiac risks, face down for up to 25 minutes total, and twice injected him with lorazepam and other drugs before he stopped breathing.

Cornell’s restraint happened without adequate supervision by a nurse.

Since the 1990s, mental-health leaders have sought to end face-down restraints, as well as other types of physical force to restrict patients’ movement, because they can cause asphyxiation and cardiac deaths. Texas regulations prohibit the face-down hold for longer than a minute.

Equip for Equality’s study concludes there is an “urgent need” to do more nationally. The group wants systemic changes such as enhanced federal oversight and sanctions against facilities and has called for reporting all such fatalities to a central database which would allow better analysis of care breakdowns and the pervasiveness of the problem.

“The total number of children and adults, including seniors, who die each year as a result of being put in restraints, is unknown,” the study says. “…There continues to be – no comprehensive oversight system in place for monitoring restraint usage and compliance with the law.”

Parkland Memorial Hospital board members are slowing down the process for picking an interim CEO to replace embattled Dr. Ron Anderson.

They signaled earlier in the week that they could make a decision by today. But they left a two-hour closed-door meeting this afternoon saying they needed more time and more information to evaluate their top prospects.

Chairwoman Lauren McDonald called the decision “huge,” saying the board owes patients and the public a deliberative process.

I reported earlier today that the three finalists – Otis Story, John Guest and Thomas Royer – had a mixed record running large hospital systems.

While all had received praise for their work, each experienced serious conflicts or problems as CEOs:

Story was fired from Grady Hospital in Atlanta after only eight months, following a dispute with his bosses.

Guest repeatedly clashed with the Harris County Hospital District board, twice resigning without explanation.

Royer’s company, Irving-based Christus Health Systems, faced a federal investigation into alleged Medicare fraud, which it later settled with the government for nearly $1 million.

Story and Guest could not be reached for comment. Royer told me on Friday that his departure had nothing to do with the investigation and that he had long planned to retire from Christus.

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Today, Parkland Memorial Hospital officials finalized a deal with federal regulators intended to usher in a new phase of safety reforms over the next 18 months that will better protect patients from needless threats of death or disease.

Known as a “systems improvement agreement,” it also rescues the Dallas County public hospital from the brink of closure. As of Friday, the U.S. Centers for Medicare & Medicaid Services was set to cut off hundreds of millions of dollars in federal funding to the hospital, money that makes up almost half its patient revenues. The deal allows a stay of termination up to 18 months so the hospital can steer itself back into compliance with federal regulations

Parkland is the largest – and only the fifth – hospital in the nation to be forced to hire independent safety monitors to remedy crisis conditions. An 18-month probationary period is needed, CMS officials said, to resolve safety issues in the emergency room, infection control and psychiatric services, among other areas.

Parkland also is contending with an investigation by the U.S. Justice Department, which monitored the most recent CMS inspection of the facility.

I’ll provide more details about the hospital’s agreement in Thursday’s edition.

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The U.S. Centers for Medicare & Medicaid Services have just released details of “immediate jeopardy” problems that inspectors found at Methodist Dallas Medical Center during a health and safety inspection last month.

The regulatory agency accepted Methodist’s written plan to correct the problems that have put the hospital’s healthcare funding at risk — making it the second Dallas hospital in the last few months to face such a penalty. We’ve posted the inspection report and corrective plan at the end of this post.

Among the major problems inspectors found, Methodist violated the Emergency Medical Treatment and Active Labor Act (EMTALA), a federal law that requires hospitals to evaluate and treat sick and injured patients before releasing or transferring them. Inspectors found similar problems at Parkland Memorial Hospital in a July inspection.

Inspectors specifically found that Methodist did not provide appropriate medical screening exams by qualified medical professionals for all patients who came to the emergency department. Patient beds in the emergency department also didn’t have nurse call lights for patients to use in the event of an emergency.Continue reading →